This case report came out recently. I found it after Zoology prompted me to check out any studies examining migraine treatment with a benzo.
Many patients with migraine are poorly responsive to conventional preventive therapies. Comorbid anxiety and depression may contribute to headache refractoriness, but studies of headache preventives have not typically addressed the patient with psychiatric comorbidity. The author has used clonazepam empirically to treat a subgroup of headache patients with associated anxiety, who were poorly responsive to conventional preventives. The use of a benzodiazepine as a headache preventive raises concerns regarding tolerance and addiction. The author presents 3 cases that illustrate different outcomes associated with this therapy, and suggests guidelines for its use.
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• Clonazepam is a long-acting, high-potency benzodiazepine that has been approved by the FDA for the treatment of seizure disorders. It is used more commonly in a variety of psychiatric disorders (especially panic disorder and other anxiety disorders), as well as other neurologic disorders (Tourette’s syndrome, movement disorders), and chronic pain syndromes, especially neuropathic pain.
• Clinicians who treat patients with migraine and associated psychiatric comorbidity have little guidance as to whether standard migraine preventives are the best choice of therapy. Some antiepileptic drugs used for migraine prophylaxis have psychotropic properties, which might contribute to their efficacy as migraine preventives.
• The author has found clonazepam to be clinically useful in patients with primary headache disorders, especially in the presence of clinical/subclinical anxiety.
• Clonazepam is effective for the treatment of panic attacks. Both generalised anxiety disorder and panic disorder are often comorbid with migraine, and clinically appear to contribute to the expression of migraine attacks.
• Clonazepam is also commonly used for the treat- ment of vertigo, although there are no double-blind trials to support its use. Vertigo is commonly comorbid with migraine, and the symptom is particularly difficult to treat.
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The author suggests the following guideline: while awaiting adequate scientific study, clonazepam may be considered for the patient with headache refractory to standard migraine preventive therapies, after appropriate psychiatric evaluation to determine the presence of depression, anxiety, and any history of chemical dependency. If the patient is being followed by a psychiatrist, the proposed treatment should be discussed with the psychiatrist. Patients who appear more likely to benefit appear to have clinical or sub-clinical anxiety, insomnia, or somatoform symptoms. Small quantities of medication should be initially prescribed, and the patient monitored closely for any sign of dose escalation or adverse effect. Patients should be informed of the potentially addicting nature of the treatment.
Check out the case studies.
Given my excellent response to valium and shocking response to all other migraine meds it’s time to try this stuff.
Note that 0.5 mg of Clonazepam (Klonopin) is equivalent to 10 mg of diazepam (Valium).